Provider Demographics
NPI:1992444335
Name:STRIDES THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:STRIDES THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA LBA
Authorized Official - Phone:435-668-8590
Mailing Address - Street 1:5700 NE 82ND AVE UNIT G38
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-9431
Mailing Address - Country:US
Mailing Address - Phone:435-668-8590
Mailing Address - Fax:
Practice Address - Street 1:5700 NE 82ND AVE UNIT G38
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-9431
Practice Address - Country:US
Practice Address - Phone:435-668-8590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1639659220Medicaid
WA1497281018Medicaid
WA1689098584Medicaid